Philip Johnston has been with the Daily Telegraph for more than 20 years. He is currently assistant editor and leader writer and was previously home affairs editor and chief political correspondent.

A&E chaos is the predictable result of GP contracts and EU interference

Mr Prior called for large-scale closures of hospital beds and investment in community care

David Prior, head of the Care Quality Commission, says hospital A&E services are in crisis because too many people are using them. They are the first port of call nowadays for primary care. But is that surprising when it is so difficult to get to see a GP without booking up days in advance? In any case you can’t go to a surgery in the evenings or at weekends because most of them are closed.

Why is that when every other profession or industry is now expected to work at weekends, doctors don’t? Passing by our big south London surgery on a Sunday is to find it dark and closed. Yes, there are supposed to be alternatives like NHS direct and locums; but people would rather see a doctor than talk to someone on the phone. So they go to the local hospital A&E, which then becomes overwhelmed.

which predicted precisely this outcome. It was written just after the new GP contract took effect and in anticipation of EU restrictions on the working hours of junior doctors.

The contract allowed GPs to opt out of working at nights and weekends, foregoing £6,000 in salary, which was to be paid over to locums, nurses, ‘‘walk-in" centre staff to provide the cover instead. Thousands accepted the deal and could you blame them when they were routinely being called out for trivial ailments. A survey that invited doctors to give examples of time-wasting calls found that one had been required to give advice on a patient's dog while another was summoned by a woman worried about a spot on her face.

The article continued: “But if a large proportion opt out of evening and weekend work and there are insufficient locums to cope with the demand, what then? The likelihood is that people who would otherwise be seen by a GP will instead flood the already over-stretched casualty departments at the local hospital….So how will the system cope if it has to deal with greater demand caused by the GP contract? More to the point, how will it cope when the Working Time Directive, the European law that limits the number of hours to be worked, hits the NHS?”

If I could foresee this fiasco, presumably Health Department could too but chose not to do anything about despite the pleas of many professionals. In 2004, James Johnson, chairman of the BMA council, said: ‘‘We have been trying to alert the Department of Health to the scale of the impending disaster for at least three years."

We are now reaping the whirlwind. Primary care is in the throes of a major upheaval but will it mean that more surgeries open at weekends and in the evening? This should not mean that doctors have to work longer hours but can't they work out rotas that people in most other walks of life have to agree? Some already offer extended hours but these usually run just to 7.30pm and then only for one night a week.

As part of its NHS reform, the government wants GP practices to routinely extend their opening hours in the evening and at weekends but many are resisting. They say that most people want better access during normal working hours but for people who commute the evenings and weekends are the only time they can go.

Figures compiled by the Department of Health last year suggested that the vast majority of patients were unhappy with the opening hours of their GP surgeries. Every practice in the country was given a mark out of 10 based on the experiences of half a million patients – and 93 per cent of the 8,400 surgeries in England were not meeting patients’ expectations in terms of their opening times.

As Katherine Murphy, chief executive of the Patients Association, said at the time: ‘Patients become extremely frustrated when they are registered with a GP who has a long wait for appointments but limited opening hours. They need the healthcare system to be responsive to their needs. Patients who work during the day would like as wide a window as possible within which to be able to book an appointment.’

The counter argument given by GPs to opening for longer is that while it would have a beneficial short-term effect, demand would quickly fill the increased capacity. Within a few months the system would be back where it started. There is something in that not least because attitudes to “bothering” your GP have changed; once going to the doctor was unusual; now we are persuaded to so when a pimple appears.

But unless this is sorted out the frustrations of genuinely ill people unable to get an appointment and the chaos at A&E will simply get worse. The response does not have to be the same everywhere – GP practices should shape their services and capacity around demand just as every other business, be it a shop or a newspaper, must to meet the needs of its customers.

When the main NHS regulator says the system is on the brink of collapse it really is time to sit up and take notice – not wait another 10 years to do something about it.